<p><a href="https://peterattiamd.com/martymakary3/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240916-pod-martymakary3&utm_content=240916-pod-martymakary3-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240916-pod-martymakary3&utm_content=240916-pod-martymakary3-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240916-pod-martymakary3&utm_content=240916-pod-martymakary3-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there's still room to challenge historic practices and embrace new approaches.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The issue of groupthink and cognitive dissonance in science and medicine [2:30];</li> <li>How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];</li> <li>How cognitive dissonance and effort justification shape beliefs and actions [13:15];</li> <li>How misguided peanut allergy recommendations created an epidemic [17:45];</li> <li>The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];</li> <li>The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];</li> <li>The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];</li> <li>The potential correlations between early antibiotic use and chronic diseases [40:45];</li> <li>The historical and evolving trends in childbirth and C-section rates [50:15];</li> <li>Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];</li> <li>Navigating uncertainty as a physician [1:19:30];</li> <li>The urgent need for reform in medical education [1:21:45];</li> <li>The major barriers to innovative medical research [1:27:30];</li> <li>The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15];</li> <li>The major successes and ongoing challenges of modern medicine [1:51:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Early Peanut Exposure for Infants
Introduce peanut products to infants between four to six months of age (not as a sole diet and avoiding choking risks with whole peanuts) to significantly reduce the risk of developing peanut allergies, based on research showing an eight-fold difference.
2. Minimize Unnecessary Antibiotics
Be judicious about antibiotic use, especially in early childhood, as studies suggest 60% of outpatient antibiotics are unnecessary and overuse is linked to increased risks of obesity, learning disabilities, ADD, asthma, and celiac disease.
3. Re-evaluate HRT for Menopause
Postmenopausal women should re-evaluate the benefits of Hormone Replacement Therapy (HRT) with their doctors, as it has been shown to significantly improve health and the initial fears of increased breast cancer deaths were unfounded.
4. Consider Fallopian Tube Removal
If you are a woman who has completed childbearing and are undergoing elective abdominal surgery, discuss with your surgeon the option of removing your fallopian tubes (salpingectomy) to massively reduce your risk of developing what is commonly called ovarian cancer.
5. Prioritize Newborn Skin-to-Skin
Advocate for immediate and prolonged skin-to-skin contact for newborns, as it acts as the best incubator, promoting more normal blood pressure, heart rate, and glucose levels for the baby.
6. Delay Umbilical Cord Clamping
Advocate for delayed umbilical cord clamping until it stops pulsating (potentially up to two minutes) to allow the baby to receive additional blood and stem cells, based on studies showing clinical benefits.
7. Explore Antibiotics for Appendicitis
If diagnosed with appendicitis without rupture or a fecolith, discuss with your doctor the option of a short course of antibiotics, which is 67% effective and avoids surgery risks.
8. Question Absolute Health Claims
Raise a ‘flag’ when health recommendations are presented with absolutism, especially if they lack clear scientific evidence, to avoid blindly trusting unproven advice.
9. Suspend Personal Biases
When evaluating new information, particularly in science, actively suspend your personal biases to maintain impeccable objectivity and avoid premature conclusions.
10. Think in Probabilities, Not Binaries
Approach scientific findings and hypotheses by thinking in terms of probability distributions rather than binary (yes/no) outcomes, allowing for continuous updating of beliefs with new information.
Understand that diet and food quality are primary drivers of obesity and diabetes, rather than solely genetic predispositions, which should inform personal health choices.
12. Challenge Deeply Held Assumptions
Embrace the purpose of science by actively challenging deeply held assumptions, rather than settling for the first idea heard, to foster objective understanding.
13. Ask Your Doctor Questions
Make asking questions a routine part of your medical consultations to better understand health recommendations and engage in your care.
14. Embrace Medical Uncertainty
Recognize that understanding unknowns and dealing with uncertainty is a crucial part of medical decision-making, both for doctors and patients.
15. Delay Newborn’s First Bath
Request to delay washing a newborn for the first 24 hours after birth, preserving the natural proteinaceous coat that provides benefits.
16. Understand Birth’s Microbiome Impact
Recognize that vaginal delivery seeds a newborn’s sterile gut microbiome with beneficial bacteria from the vaginal canal, colostrum, and skin, whereas C-section babies may be seeded with hospital bacteria, influencing birth plan discussions.
17. Choose OBs with Lower C-Section Rates
When choosing an obstetrician, consider seeking out those with C-section rates in the 12% to 15% range for low-risk deliveries, as this may indicate a more appropriate approach to childbirth.
18. Question Pre-Op Antibiotics for Minor Surgery
Discuss with your surgeon whether prophylactic antibiotics are truly necessary for minor laparoscopic procedures, as their routine use may be an outdated extrapolation from open abdominal surgeries and contribute to resistance and microbiome disruption.
19. Empathetic Medication Discussion
When discussing medication adherence, use empathetic phrasing like ‘Some people find it hard to take their medications as prescribed. How are you doing with it?’ to foster open communication rather than a confrontational tone.
20. Focus on Health Equity Solutions
Instead of merely describing health disparities, prioritize and engage in actions and research aimed at actively reducing them, as the existence of disparities is already well-known.
21. Consider a Medical Career
If you are considering a career in medicine, you are encouraged to pursue it due to the unique privilege of connecting deeply with people and helping those in need.
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